348 "SPECIALISM tN MEDtCINE.’’-BRMINGI-AM.

askance at the claims for the Fellowship of those of itsmembers whose chief work is avowedly surgical"-that isto say, that an obstetric physician may operate as much a.she likes from below: remove fibroids, cure fistula, extirpatethe uterus and ovaries per vaginam as hitherto, but once lethis knife wander above the level of the mons veneris, eventhough he feels convinced he can save his patient more surelythan by operating per vaginam, he puts himself outside thepale-the Fellowship of the College is not for such as he.This statement, Sirs, is such a serious one that in theinterests of many present-and of all future-obstetricphysicians, it surely calls for some definite ruling on

the part of the authorities of the College. Of all theobstetric physicians and assistant obstetric physiciansin London and the provinces there are, I believe, onlyfive who do not perform abdominal section ; of the five onewas a very successful ovariotomist until the claims of anextensive midwifery practice caused him to cease doingthese operations; two are prevented by the rules of the

hospital to which they have become attached from continuingto perform abdominal sections ; and the remaining two have,I believe, never so operated.

Sir W. Priestley suggests that those obstetric physicianswho perform abdominal section should take the Fellowshipof the College of Surgeons ; but as one who possesses thisvaluable diploma I would respectfully point out to the

president and council of the Royal College of Physicians that ifthey refuse the Fellowship to obstetric physicians who operateon the female pelvic organs per abdomen, and give it, as hasbeen done for many years, to those who operate per vaginam,a grave injustice will be inflicted on many gentlemen who,on becoming obstetric physicians, looked forward to beingmade Fellows of their College in due course, provided theyhad done nothing derogatory to the dignity of the pro-fession. By all means, if it is thought desirable, let it bea law that in fitture obstetric physicians who performabdominal section shall not be eligible to become Fellowsof the Royal College of Physicians, but in common justice let:such law not be retrospective. Sir W. Priestley asks : "Areour antiseptic methods a sufficient safeguard against the

possible contamination of lying-in patients by one whoundertakes extensive surgical work in addition to obstetricpractice?" " I answer emphatically " Yes ; and a man whohas operated on a pyosalpinx or a suppurating ovariantumour can, in a quarter of an hour, make it perfectlysafe for him to attend a lying-in woman." Let meask Sir W. Priestley this question, " Which is more likely tokeep himself aseptic, the obstetric physician who performsabdominal section, and who from the very fact of doingthese operations is imbued with the profound importance ofkeeping himself and all his paraphernalia aseptic, or he whodoes not so operate, but who may at any moment have toattend a midwifery case soon after examining a patientsuffering from a stinking vaginal discharge?" " Thesolution of the difficulty as to the obstetric physicianoperating Sir W. Priestley finds in "appointing a gynae-cological surgeon to every hospital, who shall work in

conjunction with the obstetric physician." If by this hemeans that every disease of the female peculiar to her sex(caruncles, polypi, vaginal cysts, uterine cancer, &c.) maybe diagnosed by the physician, but must be handed over

to the surgeon for operation, then I say that no obstetric

physician of repute will hold office under such conditions ;but if he means that the obstetric physician may (as at

the Samaritan Hospital) do whatsoever operation he likes

per vaginam, but must pass on all cases requiring abdominalsection to the surgeon, then I say that in my humble opinionit is a case of " straining at a gnat and swallowing a camel."For my part I agree with what Dr. Herbert Spencer of

University College Hospital said in a paper which he readbefore the Medical Society, that it would be a wise and

gracious act on the part of the surgeons in every hospital tohand over to their obstetric colleagues all the cases of disease ofthe female generative organs requiring abdominal section ; thishas, I believe, been done for some years at King’s College Hos-pital without friction between Dr. Playfair and his sur-

gical colleagues. In conclusion, let me repeat now what I saidin the discussion on Dr. Spencer’s paper: "As the art ofobstetrics is in great part surgical, those who practise thatart should be called obstetric surgeons, that the qualificationfor holding such a post at a hospital should be the F.R.C.S.and not the F.R.C.P., and that the existing anomaly wasthe fault not of the College of Physicians, but of the Collegeof Surgeons, which in years gone by refused to shelter

under its wing the obstetrician." Apologising for the lengthof this letter, I am, Sirs, yours faithfully,I Harley-street, Aug. 3rd, 1895. WILLIAM DUNCAN.WILLIAM DUNCAN.

"SPECIALISM IN MEDICINE."To the Editors of THE LANCET.

SIRS,—the growth of knowledge has rendered specialism"necessary. There was a time when the surgeon could com-

pass all knowledge, not only of medicine and surgery, butalso of hairdressing. Now only a Crichton could master thefacts of the various divisions of medicine and surgery, in-cluding ophthalmology, gynaecology, dermatology, laryngo.logy, otology, bacteriology, and the dozens of other " ologiespertaining to medical science. I agree, however, with theleading article in THE LANCET of July 20th when it says thatpractical experience of general medicine is advisable andnecessary before a special branch can be adequately dealt with.Unfortunately, it is becoming common for young men to studya subject with special industry before qualification with a viewto the beginning of practice at once in that subject only.To start on a professional career in this manner is likely toresult in practice of a one-sided and narrow character. Theseinfant specialists have no doubt studied the various branchesof medicine in which they are examined for theirdiplomas. But even this moderate knowledge of generalmedicine will be below that of the average newly qualifiedman on account of the undue attention given to theirselected special subject. Starting practice, then, with evenless than the average stock of general knowledge, and looking Z)

at everything with the coloured glasses of their speciality,how defective must be their apprehension and treatment ofdisease. On the other hand, he who has devoted some yearsof his life to general practice will see the inter-connexion ofthe general and special diseases, and of the latter with eachother, without which knowledge no special branch can besatisfactorily practised. Nothing else can supply this train.ing and insight, and the want of it gives a bias and narrow.ness that is the cause of most of the abuse of specialism inthose that take it up from their medical birth. Otherwise itis liable to abuse as much, and no more, than the practise ofgeneral medicine. It would be well if no one started in

special practice without having had ten years’ experience ingeneral work. I am, Sirs, yours truly,July 31st, 1895. A SPECIALIST.A SPECIALIST,

BIRMINGHAM.

(FROM OUR OWN CORRESPONDENT.)-

t

Action against a BU1’gcon.AT the present Warwickshire Assizes an action was brought

by Charles Stevenson against Dr. Eagar of Stourbridge torecover damages for alleged negligence. The plaintiff hadan accident which resulted in a dislocated shoulder, which itwas alleged had not been properly attended to. There wasskilled professional evidence on both sides as usual. It wasadmitted that the plaintiff was subject to epileptic attacks,and the defence asserted that any subsequent injury foundarose from this cause. The verdict was given for the

defendant, Dr. Eagar, who may be congratulated uponhaving cleared himself from the imputations made upon hischaracter and his skill.

Bcc7aX; Holiday.The exodus of a large number of inhabitants of the large

towns at this season of the year is growing to an enormousdegree. In this town the present time has broken record inthe enormous number who have availed themselves of cheapexcursions for short periods. And yet the advantages mustbe mixed with some alloy of risk to health. Packed in closerailway carriages, deprived of natural rest by night travelling,and subject to all the inconveniences and dangers of inclementweather, it may well be remarked that these English peopletake their pleasure sadly. The consequences follow thesedisturbed conditions of ordinary life in disorders of nutri-tion and exposure to wet and cold. If the demand forexcitement and change continues at the same rate of progresssome alteration must be made in the usual railwayarrm1ge-ments, or some measures taken to make the holidays lessuniversal. Appointing different seasons to various localities